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For Equine Vets Everywhere

PROTECT ME - Clinical Audit

Why audit antimicrobial use?
The is considerable evidence in human health that auditing antimicrobial use can be a powerful tool to changing prescribing practices. If the highest priority critically important antibiotics are used sparingly then we can preserve their effectiveness for the future.

Why more monitoring?
In the original PROTECT ME toolkit BEVA proposed that practices could promote change by providing these critically important antimicrobials with the same levels of protection as controlled drugs. Essentially that requiring extra recording associated with their use would make people stop and think before prescribing them. If you are already doing these things please continue…

In order to assist practices developing CLINICAL AUDIT protocols we are now proposing that practices audit the use of some or all of these products.

What is Clinical Audit?
Clinical audit can be applied to clinical outcomes, although these are often time consuming or rely on well structured clinical coding software. There are some processes that be audit with some ease. For example if your audit was to ‘ensure that 95% of intravenous catheters were used without complications’ you could extract catheter sales and simply record complications.

However if you wanted to ensure that 95% of horses with septic synovial structures returned to pre-injury performance you would need to extract data relating to both presentation and obtain long term follow up. Although not imposstible, it does take considerably more time to undertake.

More commonly procedures, and compliance of these, is audited. This can be applied to many areas of clinical practice to ensure compliance. As an introduction to clinical audit we are proposing an audit of antmicrobial use in your practice. BEVA will help practices to develop other clinical audits over the coming months.

What are the steps to developing clinical audit?
1.Decide what to audit
Do you want to audit use of all critically important antimicrobials (fluoroquinolones, 3rd and 4th Generation cephalosporins and macrolides)
Do you want to audit a single category, even a single drug?
2. Define the population in your audit
Do you want to audit all animals or a subset (eg adult horses)?
Auditing the whole population is easier to extract from your practice management system but It may be influenced by unique age populations (eg macrolides in foals with R equi
3. Define what data you will collect
You should define what data you are going to collect. There are many ways of recording antimicrobial use based on number of prescriptions/sales, number of doses, or number of animals treated:
4. Set a benchmark for compliance
You should a target of benchmark. for example that less than 10% of antibiotic sales will be of critically important antimicrobials. In order to select a benchmark you should
Pick a figure that sounds good / is similar to targets in human healthcare (there are no benchmarks for equine practice)
Collaborate with other practices to establish a benchmark
Establish your current usage and work as a group to establish a meaningful reduction that you believe is achievable
If you set a target that is overly ambitious you may fail to achieve this, in which case you should modify it for future audit cycles. If your target was wrong then change it, dont just give up!

5. Establish buy in from the whole practice
Or at least the majority of the practice. If some members wont comply then simply don’t use their figures
Publicise your audit using the tools available to you
Be open – it is not a competition and individuals should not be judged by their usage
6. Audit for a set period of time
Set a time limit of 1-3 months. You can always repeat again next year
Keep the practice engaged. Inform them of the outcomes of the audit
Sign up to be an antimicrobial guardian and display your poster with pride http://www.antibioticguardian.com

Auditting antimicrobial use is relatively simple and we believe it will make a painless introduction to clinical audit. Your data can all be extracted from sales figures from your practice management system each month by identifying sales for each item. It will take some time, BUT it does not require ad-hoc clinical recording